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[Diagnosis] Sleep Study: what kind of apnea do I have?
#1
Sleep Study: what kind of apnea do I have?
I was just diagnosed with OSA, and haven't purchased my machine yet.  My (weird) insurance will only cover a single one-time lifetime purchase for sleep apnea, so I want to make sure I get this right.  I'm currently planning to get a Resmed Airsense 10 Autoset, but I'm a little nervous... what if it turns out I need biPAP or ASV?  What do you think the odds of that are based on my sleep test below?  Am I very clearly OSA, or are the Central/Mixed events significant enough to be a concern down the road (I'm 43)?

       
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#2
RE: Sleep Study: what kind of apnea do I have?
I should note that they prescribed APAP using initial settings of 5-15 cwp and "C-Flex set to comfort" which I learned translates to EPR in Resmed terms. Not sure if that should be 1, 2, or 3.
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#3
RE: Sleep Study: what kind of apnea do I have?
Welcome to the forum.
This sleep study shows you were in BE sleep from the moment they started to when you stopped. That means you never were awake, you fell asleep and you never woke up. If that is true you have some serious sleep issues other than apnea.

Call your insurance as a single lifetime purchase of a CPAP is something I've never heard of. While some have run considerably longer the expected lifetime is 5 years.

Next Flex is not equivalent to EPR. While not official EPR can be used to mimic the pressure support of a BiLevel, though limited to settings of off, 1, 2, or 3. This allows for better therapeutic treatment of flow limits, RERAs, UARS, and Hypopneas.,

You have just under 3 CAI. That is below the threshold of a CAI of 5 deemed necessary to qualify for an ASV. Central Apnea is not treated by any other machine. Via increasing the trigger sensitivity setting in a ResMed BiLevel we can reduce Central Apneas in some individuals.

Tell them because of the lifetime limit of only one purchase of a CPAP you want the ResMed AirCurve 10 VAuto because of its greater versatility and this is the only machine your insurance will allow you to ever purchase.

That said the ResMed AirSense 10 AutoSet is not a bad machine.

We can help you purchase any pap machine for considerably less than what your DME charges.
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#4
RE: Sleep Study: what kind of apnea do I have?
Interesting!  What is BE sleep?

I know for certain I wasn't asleep the entire time.  It took me about 30 minutes to fall asleep, and then I got up to go to the bathroom at 6:51am and returned to bed.  That is visible on the heart rate graph.  I also have detailed logs of that night from my Apple Watch using the AutoSleep app, and it shows fairly normal sleep cycles.
   

Which part of my sleep study indicates that I may have never been awake?  Is it the blank "arousal,sec" section?  I wonder if this is due to limitations of the monitoring system.  It was an Alice NightOne home sleep test system.  The doctor's notes say, "The channels recorded were: Airflow acquired with a nasal pressure cannula and oral thermistor.  Oxygen saturation (SpO2) and pulse was monitored using a pulse oximeter.  Thoracic and abdominal respiratory movements were recorded by respiratory inductive plethysmography."  Basically I had a cannula in my nose, a pulse-ox on my fingertip, and a strap around my chest with a box on the front.

That's good to know the CAI threshold is 5, and that I'm below it. I suspect these could be due to me holding my breath for about ten seconds when I turn during my sleep.  I've verified that I often do this using the SnoreLab app.  I take a big breath, roll over, hold, and then do a big exhale.

My official prescription calls for APAP.  I wonder if insurance might claim that the AirCurve 10 VAuto doesn't qualify as APAP.  Is it accurate to say that the AirCurve 10 VAuto can be made to function equivalently to "Autoset" mode, as well as offering a variety of additional modes and adjustments?

Also, my sleep study AHI is "only" 13.1, in the mild range.  My uninformed assumption is that this means I don't need as much pressure to treat it, but that could be completely wrong.  I believe one of the AirCurve's selling points is that it allows for higher pressures and PS, which I might not need.  As you say, only an ASV really helps with centrals, so the VAuto doesn't compensate for that possibility any more than the Autoset.  So is the main VAuto selling point the ability to increase the pressure more than with an Autoset, and possibly more responsive, comfortable algorithms and ability to fine-tune the algorithms?
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#5
RE: Sleep Study: what kind of apnea do I have?
(10-05-2020, 04:15 PM)orand Wrote: Interesting!  What is BE sleep?
N2, not sure how that got in there.  Sleep Stages is where I saw that and knew that that was wrong.

I know for certain I wasn't asleep the entire time.  It took me about 30 minutes to fall asleep, and then I got up to go to the bathroom at 6:51am and returned to bed.  That is visible on the heart rate graph.  I also have detailed logs of that night from my Apple Watch using the AutoSleep app, and it shows fairly normal sleep cycles.


Which part of my sleep study indicates that I may have never been awake?  
N2, not sure how that got in there.  Sleep Stages is where I saw that and knew that that was wrong.

Is it the blank "arousal,sec" section?  I wonder if this is due to limitations of the monitoring system.  It was an Alice NightOne home sleep test system.  The doctor's notes say, "The channels recorded were: Airflow acquired with a nasal pressure cannula and oral thermistor.  Oxygen saturation (SpO2) and pulse was monitored using a pulse oximeter.  Thoracic and abdominal respiratory movements were recorded by respiratory inductive plethysmography."  Basically I had a cannula in my nose, a pulse-ox on my fingertip, and a strap around my chest with a box on the front.

That's good to know the CAI threshold is 5, and that I'm below it. I suspect these could be due to me holding my breath for about ten seconds when I turn during my sleep.  I've verified that I often do this using the SnoreLab app.  I take a big breath, roll over, hold, and then do a big exhale.

My official prescription calls for APAP.  I wonder if insurance might claim that the AirCurve 10 VAuto doesn't qualify as APAP.  Is it accurate to say that the AirCurve 10 VAuto can be made to function equivalently to "Autoset" mode, as well as offering a variety of additional modes and adjustments?
You could make that argument, they may say sorry AutoSet.

Also, my sleep study AHI is "only" 13.1, in the mild range.  My uninformed assumption is that this means I don't need as much pressure to treat it, but that could be completely wrong.  I believe one of the AirCurve's selling points is that it allows for higher pressures and PS, which I might not need.  As you say, only an ASV really helps with centrals, so the VAuto doesn't compensate for that possibility any more than the Autoset.  So is the main VAuto selling point the ability to increase the pressure more than with an Autoset, and possibly more responsive, comfortable algorithms and ability to fine-tune the algorithms?
You cannot fine tune the algorithim, The VAuto has Pressure Support, which is absent from the AutoSet (EPR is a 'comfort' feature) and, is used to treat Hypopnea, Flow Limits, RERAs, and UARS.  
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#6
RE: Sleep Study: what kind of apnea do I have?
Note that the doctor and/or DME has already selected that you will be getting a Respironics as they mention Flex. Only get a ResMed as these have proven better at therapy and seem to mostly last longer without problems. They are not offering a choice, so you must demand the machine you want. It is your choice to make, not theirs. Same goes for the mask, you choose it. If they tell you machine choices in brand does not make a difference, do not buy this false statement. Machine brand does matter. If they say they only sell Respironics, find out what other DMEs are in-network according to your insurance customer service. Call the insurance to see who they say are in-net. And do clarify the one purchase only ever on the PAP. I've never heard insurance saying that. And the DME does not need your credit card, bank account, or debit card info. Refuse to give this to them.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#7
RE: Sleep Study: what kind of apnea do I have?
(10-05-2020, 01:03 AM)orand Wrote: I was just diagnosed with OSA, and haven't purchased my machine yet.  My (weird) insurance will only cover a single one-time lifetime purchase for sleep apnea, so I want to make sure I get this right.  I'm currently planning to get a Resmed Airsense 10 Autoset, but I'm a little nervous... what if it turns out I need biPAP or ASV?  What do you think the odds of that are based on my sleep test below?  Am I very clearly OSA, or are the Central/Mixed events significant enough to be a concern down the road (I'm 43)?

This policy from your Insurance is absurd on the face of it.  The projected usable life of a CPAP machine, any class is 5 years.  What are you expected to do then?  I would be talking directly with the insurance company, if you aren't already.  If they confirm this stupid policy, I would look for other insurance, if you have that option.  This is simply not realistic.  Machines wear out or fail, but sleep apnea doesn't disappear - there is no cure, only treatment.  It is also ludicrous to assume that the sleep test and initial prescription will get it right - experience for many shows this is not the case
A.Becker
PAPing in NE Ohio, with a pack of Cairn terriers
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